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South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

Kerber KJ, Lawn JE, Johnson LF, Mahy M, Dorrington RE, Phillips H, Bradshaw D, Nannan N, Msemburi W, Oestergaard MZ, Walker NP, Sanders D, Jackson D - AIDS (2013)

Bottom Line: All estimates were compared with available empirical data.Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005.Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries.

View Article: PubMed Central - PubMed

Affiliation: aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.

ABSTRACT

Objective: To analyse trends in under-five mortality rate in South Africa (1990-2011), particularly the contribution of AIDS deaths.

Methods: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data.

Results: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37-39% of child deaths were due to AIDS in 2004-2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%.

Conclusion: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall.

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Antenatal HIV prevalence and prevention of mother-to-child transmission (PMTCT) scale up in South Africa, 1990–2010.
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Figure 4: Antenatal HIV prevalence and prevention of mother-to-child transmission (PMTCT) scale up in South Africa, 1990–2010.

Mentions: Although interventions to address HIV/AIDS have been undertaken in the broader context of the district health system, mortality audit data and sample sites across the country also indicate that these interventions have reduced AIDS deaths without a significant knock-on effect for other causes of child death. The trajectory for child survival has shifted as PMTCT services and ART have become more widely available (Fig. 4) [13]. Access to treatment and improved survival rates have meant that the overall HIV prevalence amongst women attending antenatal care has not changed significantly nationally since 2005 [29]. Uptake of PMTCT services is high, with more than 98% of women getting tested for HIV during pregnancy and 92% of HIV-positive mothers receiving peripartum ART or prophylaxis in 2010 [27]. The decline in the rate of vertical transmission before 6 weeks has exceeded expectations and has led to calls for the elimination of perinatal HIV transmission, but there is more work to be done. Significant variability remains in PMTCT service coverage and quality across the country and the scale-up of child ART has been slower than PMTCT services [13]. In addition, the potential of postnatal transmission through breastfeeding must continue to be addressed in light of the welcome policy shift towards exclusive breastfeeding since 2010.


South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

Kerber KJ, Lawn JE, Johnson LF, Mahy M, Dorrington RE, Phillips H, Bradshaw D, Nannan N, Msemburi W, Oestergaard MZ, Walker NP, Sanders D, Jackson D - AIDS (2013)

Antenatal HIV prevalence and prevention of mother-to-child transmission (PMTCT) scale up in South Africa, 1990–2010.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815090&req=5

Figure 4: Antenatal HIV prevalence and prevention of mother-to-child transmission (PMTCT) scale up in South Africa, 1990–2010.
Mentions: Although interventions to address HIV/AIDS have been undertaken in the broader context of the district health system, mortality audit data and sample sites across the country also indicate that these interventions have reduced AIDS deaths without a significant knock-on effect for other causes of child death. The trajectory for child survival has shifted as PMTCT services and ART have become more widely available (Fig. 4) [13]. Access to treatment and improved survival rates have meant that the overall HIV prevalence amongst women attending antenatal care has not changed significantly nationally since 2005 [29]. Uptake of PMTCT services is high, with more than 98% of women getting tested for HIV during pregnancy and 92% of HIV-positive mothers receiving peripartum ART or prophylaxis in 2010 [27]. The decline in the rate of vertical transmission before 6 weeks has exceeded expectations and has led to calls for the elimination of perinatal HIV transmission, but there is more work to be done. Significant variability remains in PMTCT service coverage and quality across the country and the scale-up of child ART has been slower than PMTCT services [13]. In addition, the potential of postnatal transmission through breastfeeding must continue to be addressed in light of the welcome policy shift towards exclusive breastfeeding since 2010.

Bottom Line: All estimates were compared with available empirical data.Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005.Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries.

View Article: PubMed Central - PubMed

Affiliation: aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.

ABSTRACT

Objective: To analyse trends in under-five mortality rate in South Africa (1990-2011), particularly the contribution of AIDS deaths.

Methods: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data.

Results: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37-39% of child deaths were due to AIDS in 2004-2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%.

Conclusion: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall.

Show MeSH
Related in: MedlinePlus